VA issues have been longstanding

Fri, May 23, 2014 @ 4:27 pm

The most shocking fact about the revelations of mismanagement at the Veterans Administration is how long these problems have persisted.

New revelations continue to pile up, including three employees of the Gainesville mental health department who were put on leave after a secret waiting list was found with names of more than 200 patients.

VA head Eric Shinseki has been ineffective so far while people are stuck on waiting lists.

In testimony before the Senate, Shinseki said he is “mad as hell” about allegations of deaths and cover-ups at VA facilities. He told the committee that he thought these scandals were isolated cases.

A DECADE OF PROBLEMS

Isolated? The need for reform dates more than 10 years. Obama took office promising reforms.

Sen. Patty Murray, D-Wash., noted these issues have been reported for at least 14 years. “We have come to the point where we need more than good intentions.”

A whistleblower reported that as many as 40 people died waiting for care in Phoenix though officials say none of the deaths were directly related to the lack of care. Similar reports are popping up around the nation.

CNN cited VA documents that veterans are dying or suffered serious injuries because of delays in diagnosis or treatment screenings like colonoscopies.

At issue are cash bonuses and career advancement that were connected to seeing patients on time.

Four years ago many of these problems were revealed in detail. A report from the VA itself in 2010 described the many ways that schedules were being manipulated.

Gaming the system, cooking the appointment books, was a sophisticated practice. Some examples:

■ Patients were told they needed to check in 15 minutes before the canceled appointment, giving the facility a chance to reschedule. That appointment would be then listed as “cancelled by patient,” allowing the performance measure not to show a delayed appointment.

■ Scheduling the new patient visit at a time the patient doesn’t prefer, then rescheduling.

■ Creating a new patient appointment without notifying the patient, creating the likelihood of a no-show and a rebooking with a new start time.

■ Scheduling many patients into one block of time such as 8 a.m. to noon.

■ Cancelling patients before the appointment if the patient does not confirm.

■ Offering appointments to patients beyond the acceptable date, then documented falsely as being within acceptable times.

So this was four years ago. No reasonable person could think that this indicated an isolated instance. There could be other reasons for being unable to schedule appointments, such as poor systems, bad management and inadequate resources.

But no solutions could be found while the appointment books were being cooked.

MULTIPLE INVESTIGATIONS

A series of reports from the Government Accountability Office and the VA’s own Inspector General have underscored these points — all with pitifully inadequate responses from the VA.

For instance, in 2012 the GAO reported that appointment wait times were “unreliable.” Four centers were inspected and all had major problems.

A GAO official, Debra Draper, told Congress that since 2012 the VA has made “minimal progress at best.” She said VA has a problem just answering the phone and returning messages.

Last September, in a report from the Office of Special Counsel, serious deficiencies were reported at the VA facility in Jackson, Miss.

Whistleblowers were physicians themselves

Despite disclosures by physicians there, “the Department of Veterans Affairs has consistently failed to take responsibility for identified problems,” the special counsel reported.

A physician at the Jackson facility reported that there were only three full-time primary care physicians there, that most patients were seen by one of about 19 nurse practitioners.

At the same time, appointments were overscheduled, resulting in an overworked staff. Walk-ins were scheduled along with overbooked appointments, further stressing the system.

Because of the overbooking, the special counsel reported, “patients were frequently scheduled in ‘ghost’ or fictional clinics.”

Of course, there was nothing fictional about this to the frustrated and suffering patients.

Another of the allegations is a pay-for-performance system turned into rushed services such as reading radiology images.

In April, Shinseki ordered an audit of every VA center. Also, the VA is in the middle of consolidating call centers to better manage employees.

But this frankly is not a system issue, it’s a management one. Clearly there is a toxic culture that infects the largest integrated health care system in the country.

Rep. Jeff Millter, chairman of the House Committee on Veterans Affairs, said in a statement that clerks at the Fort Collins clinic were “taught how to cook the books.” Given the detail of the dual system, that is believable.

Is Shinseki the right person to fix it? He hasn’t been so far. He will need show much better leadership.

I'm generally supportive of our President and don't buy into all the conspiracies but I sure wish he would acknowledge that not every leader of the free world can be a strong administrator. Contrary to other's beliefs, I don't think there's much in common between running a government and running a large corporation, but what's happening at the VA (and the IRS and during the rollout of ACA) might have been averted if he had employed tactics that are employed in massive enterprises the world over. I didn't think Romney would have done any better, but a Gerstner (from IBM), Mulally (from Ford) or Bloomberg and a dozen or so others who have well-earned reputations for solving big and complex problems would have executed better and have the temperament to get the job done.